Research Paper on Prevention of Delirium

Introduction

Delirium is the mostly prevented state in patients who are under critical care unit in hospitals. It is defined as a state when the patient lacks concentration and goes unconscious unwillingly, in many cases, there is an underlying cause.8 Delirium must be managed or prevented to avoid adverse effects in patients.3 This is a condition which is associated with organ dysfunction which in most cases it is the neurotransmitters.

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The preventive measures for this condition are divided into pharmacological and non-pharmacological to make it easy to understand how effective they are in their purpose. As will be discussed in this paper, prevention measures used are to be effective for the prevention and management to be effective.9

To treat or prevent delirium, the doctor or person trying to react to it must know the causes of delirium before deciding on what should be done. This condition has some of the factors which promote its occurrence, they are; old age, infections, the severity of a specific medical condition, dementia, lack of electrolyte balance, medication, poor ventilation, nervous problems and lack of balanced diet intake.3 In dealing with this condition, it is expected that those factors should be regularly controlled and avoided if necessary.

A mobilization is an important approach to preventing delirium, this is a non-pharmacological means that entails earlier exercises and ventilation.7 Early mobility and exercise is important in reducing the days of delirium in the patient under critical care unit. By this, it means that the patient will reduce his or her days in the mechanical ventilation, therefore, making it cheap for the patient. This does not only make it cheap but also safer for the patient under the critical care unit. This is an intervention done by hospital nurses, physiotherapists or any other physician, the patient is helped with doing exercise.

To ensure this mobilization is done, there should be proper education on the staff such as nurses who will then know how to deal with this condition.2 With this it can be easy to identify delirium and good medication is taken to prevent its adverse effects. Proper selection of which drugs should be used by which patients still matter, it is due to this that the education of the staff is still effective in this process. Through education, they are made aware of on which opioid to use in managing pain and in which concentration, they are also made to know when they should be ensuring room ventilation is kept and when to use mechanical ventilation.

On the other hand, one may prefer to use the pharmacological means to counter this syndrome. This is by use of drugs. Use of drugs has been found to be effective by some researchers but others come up with their research which goes against earlier discoveries. For instance, the use of haloperidol has been associated with reduced delirium incidence. However, some researchers do not support this. This means that the use of drugs should not be among the first options to go for. Drugs such as Dexmedetomidine in most cases have been associated with a reduction of the period of delirium. However, this drug does not have a preventive function.

For the non-pharmacological measures, the physical or a hospital staff that is giving care to the patient in a critical care unit is expected to regulate the stressors that are bound to affect the sleeping pattern of patients.10 Examples of stressor that can affect sleep patterns are light and too much noise. When sleep is disturbed it can lead to a situation which is characterized the same way as delirium. So when sleep is not disturbed, then the patients will not be affected, hence delirium will be prevented.

Noise can be controlled by the introduction of earplugs to patients at a certain period of time, this will prevent some sounds that may be disturbing to them from affecting them. Earplugs are essential in reducing noise when it is inevitable, this means that confusion and discomfort that are associated with a lack of sleep can be avoided. Causes such as malnutrition are easy to correct as a preventive measure, a balanced diet must be met for those patients.

The pharmacological preventive measures are responsible for regulation of concentrations of drugs used in surgery for pain management. Such include benzodiazepines which do fall under the class of deliriogenic drugs. Deliriogenicdrugs are those drugs which are known to be causing delirium in patients.

Use of drugs such muscle relaxants may make the situation worse, they are therefore avoided in treating the critically ill patients. This process of recovery will still require the non-pharmacological intervention, such include monitoring of the patient to check if drugs are toxic to the body or beneficial. The use of patient reports is important measures in the process of monitoring.17,18 Data should be collected to dictate on which medication should be used for what reason.

Conducting of orientation will help individuals who are under critical care unit to get to understand the state that they are and avoid unnecessary panic.5,15 This will help in relaxing the mind, the mind will be oriented to a specific schedule to avoid exhausting it. This scheduling technique is to have time for specific things such as sleeping time and eating time.4 Patients being kept hydrated is an important issue as dehydration promotes delirium. It is, therefore, the role of physicians to ensure that critical care patients are safe through regular intake of water. Water can also be delivered into their bodies through infusion.

Before any kind of pain management is repeated, the nurse or caregiver should give the patient time to explain what the drug does to him or her in terms of benefits and demerits.17 This helps in getting to know if a certain drug is beneficial, delirium is in most instances associated with pain in patients who are under intensive critical care unit, this is because most of them undergo surgical procedures which are so painful.1 This kind of pain may make them end up in a delirium state.4

For the patients who do not talk, it is still easy to tell their side about the pain being managed. This is ensured through checking on the facial expression of such patients towards the drugs.19 Some may move upper limbs to signify rejection or acceptance. Through this, the nurse or care attendant will interpret. Compliance with mechanical ventilation also serves as a way to identify if the patient is benefiting from such a method of controlling pain. This is a measure that should be taken to ensure proper drugs are administered.

It is also advisable that some pains should be managed by making sure wounds of patients are stable and washing them using friendly means such as the use of warm water when it is cold.1, 13 The patients should also keep being repositioned in their bed sleeping positions. This is because some positions may make the pain to be more hence promoting the possibility of delirium. Repositioning may also help in preventing positioning stresses which may cause delirium. The caregiver is expected to reposition patients to also serve as an exercise to them.11

The spontaneous breathing trials are important in ensuring that patients in the intensive critical care unit reduce their sedation caused by opioid analgesics which are also associated with delirium despite their controlling pain as another cause of delirium.6,7 This is done by regularly titrating sedatives, therefore, ensuring improvement without necessarily having to make patients sedated all the time. It is also done through discontinuation of these sedative drugs for a specific period of time to allow for their awakening.16

A non-pharmacological stand is also important; there should be guidelines which are provided to clinical caregivers on how to deal with the critical patients. It is advisable that guidelines be made available on the identification of a delirium incidence and direction on how to deal with patients who are prone to delirium.2 The nurses and caregivers should be made to know the non-pharmacological way of dealing with delirium, this will help them to keep it in their fingertips.14 There is a need for training to make them be aware of certain gestures made by patients who do not talk.5 The need for every patient to be taken through early mobilization and exercise should be taken seriously.

Conclusion

To sum up, the above moves are important because it is not recommended to use pharmacological means to counter delirium or comma. Non-pharmacological options are the safest to go for.20 It is also confirmed that some drugs associated with preventing delirium such as Ketamine (in cardiac surgery patients) are instead responsible for hallucinations and nightmares in patients.6, 12

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